Civic Plus - Insurance Certificate (2020)Act 06/1CERTIFICATE OF LIABILITY INSURANCE °ATEcM2//2°/YYYY'
`64. �' I 019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER ( CONTACT Brooke Steiner
NAME:
C&W Insurance + PHONE (785) 537-1600 Fax ( 785 537-1657
)
(AIC, No. Ext): (A/C, No):
555 Poyntz Avenue, Suite 205 E-MAIL SS: bsteiner@charlsonwilson.com
ADDRE
P.O. Box 1989 I INSURER(S) AFFORDING COVERAGE NAIC #
Manhattan KS 66505-1989 I INSURERA: Great Northern Insurance Company 20303
INSURED INSURER B: Federal Insurance Company 20281
CivicPlus, LLC I INSURER C :
302 S. 4th Street, Suite 500 I INSURER D :
INSURER E :
Manhattan KS 66502 I INSURER F :
COVERAGES CERTIFICATE NUMBER: 2019 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION. OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AUUCbUt:$W POLICY EFF : POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDNYYY) (MM/DD/YYYY) LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED 2,000,000
I CLAIMS -MADE ® OCCUR I PREMISES (Ea occurrence) $
I MED EXP (Any one person)
$ 10,000
_
A Y
36025312
05/17/2019
05/17/2020 PERSONAL&ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
I GENERAL AGGREGATE
$ 2,000,000
X POLICY ❑ PRO ❑ LOC
JECT
PRODUCTS - COMP/OP AGG
$ 2,000,000
OTHER:
Technology E&O
$ 3,000,000
AUTOMOBILE LIABILITY
_
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
X ANYAUTO
BODILY INJURY (Per person)
$
B OWNED SCHEDULED Y
73588792
05/17/2019
05/17/2020 I BODILY INJURY (Per accident)
$
_ AUTOS ONLY AUTOS
HIRED NON -OWNED
I PROPERTY DAMAGE
$
_ AUTOS ONLY AUTOS ONLY
(Per accident)
X UMBRELLA LIAB X OCCUR
EACH OCCURRENCE
$ 5,000,000
B EXCESS LIAB H CLAIMS -MADE
79894914
05/17/2019
05/17/2020 I AGGREGATE
$
DED I I RETENTION $
$
WORKERS COMPENSATION
I XI SPER TATUTE I I EORH
AND EMPLOYERS' LIABILITY - Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
I E.L. EACH ACCIDENT
1,000,000
B OFFICER/MEMBER EXCLUDED? N !A
71749249
05/17/2019
05/17/2020
$
(Mandatory in NH)
I E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1,000,000
$
General Aggregate
$3,000,000
Cyber Liability
B
36025312
05/17/2019
05/17/2020
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Gilroy, its officers, officials and employees ACCORDANCE WITH THE POLICY PROVISIONS.
7351 Rosanna Street
AUTHORIZED REPRESENTATIVE
T.
Gilroy CA 95020
I
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
COMMERCIAL AUTOMOBILE
THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
This endorsement modifies the Business Auto Coverage Form
1, EXTENDED CANCELLATION CONDITION
Paragraph A.2.b.—CANCELLATION -mfthe
COMMON POLICY CONDITIONS form |LOO17|a
deleted and replaced with the following:
b. 8Udays before the effective date ofcancellation if
wecancel for any other reason.
2. BROAD FORM INSURED
A. Subsidiaries and Newly Acquired or Formed
Organizations AmInsureds
The Named Insured shown |nthe Declarations is
amended toinclude:
1. Any legally incorporated subsidiary in which
you own more than 5D96ofthe voting stock on
the effective date ofthe Coverage Form.
However, thaNar?edInsured does not include
any subsidiary that ieon"\naunud"under any
other automobile policy orwould bean
^inaunyd"under such opolicy but for its
termination orthe exhaustion ofits Limit cf
Insurance.
2. Any organization that inacquired orformed by
you and over which you maintain majority
ownership. However, the Named Insured
does not include any newly formed oracquired
organization:
(a)That iaon"inaured"under any other
automobile policy;
(b)That has exhausted its Limit ofInsurance
under any other policy; ur
(c)18Odays ormore after its acquisition or
formation byyou, unless you have given
uowritten notice ofthe acquisition nr
formation.
Coverage does not apply to"bodily injury" or
"property damage" that results from an"occident"
that occurred before you formed oracquired the
organization.
B. Employees aaInsureds
Paragraph A.1.—WHO IS AN INSURED —cf
SECTION || —L|AB|L|TY COVERAGE is amended to
add the following:
d. Any "employee" ofyours while using o
covered "auto" you don't own, hire or
borrow in your business myour personal
affairs.
C. Lessors amInsureds
Paragraph A.1.—WHO |8ANINSURED —of
SECTION ||— LIABILITY COVERAGE io
amended toadd the following:
e The lessor ofacovered ^euto"while the
°auto"ialeased toyou under owritten
agreement if:
(1) The agreement requires you to
provide direct primary insurance for
the lessor; and
(2) The "euto"|aleased without udriver.
Such leased ''auto"will beconsidered a
covered ^euto"you own and not acovered
"outo"yuu hire.
However, the lessor imon"|nmunod" only
for "bodily injury" or"property damage"
resulting from the acts oromissions by:
1. You;
'
2. Any ofyour ^employeom"oragents;
or
3. Any person, except the lessor cx
any "emp|oyee"oragent cfthe
|euaor, operating an ^outo"with the
permission ofany of1.and/or 2.
above.
D. Persons And Organizations As limsuneds
Under AVVritten|nsunedContract
pmraqraPh,&1�WHO |S f\M]NSURED—of
SECTION U-L|ABUL|TyCOVERAGE is
amendedto add - the �d|ow�Q:
t Any ppnaonororg�nizat|onwith respect to
the openadon ma[nt oyuse ofa
covem*d,autb",provided that y6uand
such person ororganization 'have agreed
under anexpress 'Prov}pk»n|naxvdtten
"insumydcontract" .written agree manLor a
written permit issued toyoubye
governmental orp h|i horitytoedd
' such person, ororganization tothis policy
auan"inaurod".
Howe yer.au�hperson or organization is
on"|nsunad"only:
Form: 18-02-0292(Rev. 11-16) Page of
3.
a0
5.
(1) with respect to the operation,
maintenance or use of a covered
to auto"; and
(2) for. "b6dily injury" or "propLirty'darneige"
caused by an 'accident" which takes
place after:
(a) You executed the "insured
.greeme.nt; or
(b) The permit has been issued to
FELLOW EMPLOYEE COVERAGE
EXCLUSION B.5.'FELLOW EMPLOYEE —of
SECTION U—LIABILITY COVERAGE does not apply.
PHYSICAL DAMAGE — ADDITIONAL TEMPORARY
TRANSPORTATION EXPENSE COVERAGE
Paragraph A.4.a.—TRANSPORTATION EXPENSES
—ofSECTION III — PHYSICAL DAMAGE
COVERAGE iaamended to provideolimit of$SOper
day for temporary transportation expense, subject tom
maximum, limit of$1.00O.
AUTO LOA&ULEASE GAP COVERAGE
Paragraph A.4.—COVERAGE EXTENSIONS -of
SECTION III — PHYSICAL DAMAGE COVERAGE |a
amended toadd the following:
o.Unpaid Loan mrLease Amounts
|nthe event ofototal "|oms"toacovered '`auto" we will
'
pay any unpaid amount due mnthe loan orlease for o
covered "auto"minus:
1. The amount paid under the Physical Damage
Coverage Section ofthe policy; and
2. Any:
e. Overdue loan/lease payments etthe time of
the "loss";
b. Financial penalties imposed under olease for
excessive use, abnormal wear and tear or
high mileage;
c. Security deposits not returned bythe lessor:
d. Costs for extended warranties, Credit Life
Insurance, Health, Accident orDisability
Insurance purchased with the loan orlease;
. and
e. Carry-over balances from previous loans or
leases.
We will pay for any unpaid amount due onthe loan or
lease ifcaused by:
1. Other than Collision Coverage only if the
Declarations indicate that Comprehensive
Coverage iaprovided for any covered ^outo";
2. Specified Causes ofLoss Coverage only ifthe
Declarations indicate that Specified Causes of
Loss Coverage |eprovided for any covered ^outo^;
or
3. Collision Coverage only ifthe Declarations indicate
that Collision Coverage isprovided for any
covered "auto.
6. RENTAL AGENCY EXPENSE
'
Paragraph A.4.—COVERAGE EXTENSIONS —of
SECTION III — PHYSICAL DAMAGE COVERAGE
ieamended toadd the following:
d. Rental Expense
VVewill pay the following expenses that you or
any ofyour ^ampdoymma are legally obligated
topay because ofawritten contract cx
agreement entered. into for use oforental
vehicle inthe conduct ofyour business:
MAXIMUM VVEWILL PAY FOR ANY ONE
CONTRACT OR AGREEMENT:
1. $2'5OOfor loss ofincome incurred bythe
rental agency during the period oftime that
vehicle ioout ofuse because ofactual
damage to, or '1oas^ of, that vehicle, including
income lost due toabsence ofthat vehicle for
use eaareplacement;
2. $2.5OOfor decrease intrade-in value ofthe
rental vehicle because ofactual damage to
that vehicle arising out of covered "loss"; and
3. $2.5OOfor administrative expenses incurred
bythe rental agency, aastated inthe contract
or agreement.
4. $7.5OOmaximum total amount for paragraphs
1.,2.and 3.combined.
7. EXTRA EXPENSE —BROADENED COVERAGE
Paragraph A.4. —COVERAGE EXTEN0IONS —of
SECTION III — PHYSICAL DAMAGE COVERAGE
iaamended toadd the following:
e. Recovery Expense .
VVewill pay for the expense ofreturning o
stolen covered "auto^toyou.
O. AIRBAG COVERAGE
Paragraph B.3.a.'EXCLUSIONS —ofSECTION
III —PHYSICAL DAMAGE COVERAGE does not
apply to the accidental or unintended discharge of
an airbag. Coverage is excess over any other
collectible insurance or warranty specifically
designed to provide this coverage.
8. AUDIO, VISUAL AND DATA ELECTRONIC
EQUIPMENT - BROADENED COVERAGE
Paragraph C.1.b.—LIMIT OFINSURANCE -nf
SECTION |||,- PHYSICAL DAMAGE |odeleted
and replaced with the following:
b. $2.000 is the most we will pay for "|oao" in any
one "000ident'toall electronic equipment that
naproduoeo, receives or transmits oudio, xiauo|
ordata signals which, atthe time of"|oes". is:
(1) Permanently installed in orupon the
covered "auto" in a housinQ, opening or
other location that is not normally used by
the "auto"manufacturer for the installation
of such equipment;
(2) Removable from o permanently installed
housing unit as described in Paragraph
2.a.above or -is onintegral part ofthat
equipment; or
(3) An integral pert of such equipment.
10iGLASS REPAIR —WAIVER OF DEDUCTIBLE
Form: 16-02-0292(FWay. 11-16) Page 2of3
"Includes copyrighted material ofInsurance Services Office, Inc. with its permission"
Under Paragraph D.'DEDUCTIBLE -of
SECTION III - PHYSICAL DAMAGE COVERAGE
the following isadded:
Nodeductible applies toglass damage ifthe glass
iorepaired rather than replaced.
11.TVVO ORMORE DEDUCTIBLES
Paragraph D.- DEDUCTIBLE - of SECTION III -
PHYSICAL DAMAGE COVERAGE is amended to
odd the following:
|fthis Coverage Form and any other Coverage
Form orpolicy issued toyou byuothat ienot an
automobile policy Coverage Form applies tothe
same ^ooc|dent".the following applies:
1. |f-the deductible under this Business Auto
Coverage Form |athe smaller (or smallest)
deductible, itwill bewaived; or
2. |fthe deductible under this Business Auto
Coverage Form ianot the smaller (or smallest)
deductible, itwill bereduced bythe amount of
the smaller (or smallest) deductible.
12. AMENDED DUTIES fNTHE EVENT OF
ACCIDENT, CLAIM, SUIT ORLOSS
Paragraph A2.e.-DUTIES |NTHE EVENT OF
ANACCIDENT, CLAIM, SUIT ORLOSS of
SECTION N-BUSINESS AUTO CONDITIONS io
deleted and replaced with the following:
e. |nthe event of"accidont".claim, "muit"or
"/ome^.you must promptly notify uowhen the
" accident" iaknown to:
(1) You oryour authorized representative, if
you are anindividual;
(2) Apartner, orany authorized
representative. ifyou are apartnership;
(3) Amember, ifyou are elimited liability
company; or
(4) An executive officer, insurance manager,
orauthorized representative, ifyou are on
organization other than apartnership or
limited liability company.
Knowledge ofmn"amcident".claim, ^su|f'or
"|oea"byother persons does notimp| that the
persons listed above have such knowledge.
Notice to us should include:
(1) How, when and where the ^eccidant"or
"loss" occurred;
(2) The ^inaured's"name and address; and
(3) Tothe extent possible, the names and
addresses ofany injured persons or
witnesses.
13. WAIVER OF SUBROGATION
Paragraph&5. -TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US of
SECTION |V- BUSINESS AUTO CONDITIONS is
deleted and replaced with the following:
5. We will waive the right of recovery we would
otherwise have against another person or
organization for "loss" to which this insurance
applies, provided the "insured" has waived
their rights of recovery against such person or
organization Under a contract or agreement
that is entered into before such "loss".
Tothe extent that the "insured's"rights to
recover damages for all orpart ofany
payment made under this insurance has not
been waived, those rights are transferred to
us. That person ororganization must do
everything necessary tosecure our rights and
must donothing after "eoo|dent"or"|oaa"to
impair them. Adour request, the insured will
bring suit ortransfer those rights touaand
help uuenforce them.
14.UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
Paragraph 8.�.-CONCEALMENT,
MISREPRESENTATION orFRAUD ofSECTION
|V-BUSINESS AUTO CONDITIONS -iedeleted
and replaced with the following:
ifyou unintentionally fail todisclose any hazards
existing at the inception date of your po|icy, we will
not void coverage under this Coverage Form
because ofsuch failure.
15. AUTOS RENTED BfEMPLOYEES
Paragraph 8.5.-OTHER INSURANCE of
SECTION K/-BUSINESS AUTO CONDITIONS '
iaamended toadd the hd|owinO:
e. Any "auto" hired or rented byyour "emp|oyee"
onyour behalf and sdyour direction Will be
considered en"outn"you hire. |fen
"omp|oymo's"personal insurance also applies
ononexcess basis toacovered "outo^hired
orrented byyour ''emp|oyme''onyour behalf
and mtyour direction, this inournncewill bo
primary tothe ^emp|oyee'a"personal
insurance.
16. R(REDAUTO-COVERAGETERR|TORY
Paragraph B.7.b.(5).-POLICY PERIOD,
COVERAGE TERRITORY of SECTION IV -
BUSINESS AUTO CONDITIONS is deleted and
replaced with the following:
(5)Acovered ^outn"ofthe private passenger
type is |eaaed, hired, rented or borrowed
without adriver for eperiod of4Sdays or
|eos'. and
17. RESULTANT MENTAL ANGUISH COVERAGE
Paragraph C.of'SECTION V-DEFINITIONS im
deleted and replaced bythe following:
"Bodily injury" means bodily injury, sickness or
disease sustained byany person, including
mental anguish ordeath eoeresult ofthe "bodily
injury" sustained bythat person.
Form: 1G-O2-O2B2(R�v. 11-18) pmoe3of3
' -
"Includes copyrighted material ofInsurance Services Office, Inc. with its permission"
C F-1 U S B" Liability Insurance
Endorsement
Policy Period
MAY 17, 2019 TO MAY 17, 2020
Effective Date
MAY 17, 2019
Policy Number
3602-53-12 MIN.
Insured
CIVICPLUS, LLC
Name of Company
GREAT NORTHERN INSURANCE COMPANY
Date Issued
June 13, 2019
t
This Endorsement applies to the following forms:
GENERAL LIABILITY
Under Who Is An Insured, the following provision is added.
Who Is An Insured
Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you
Scheduled Person are obligated pursuant to a contract or agreement to provide them with such insurance as is
Or Organization afforded by this policy.
However, the person or organization is an insured only:
• if and then only to the extent the person or organization is described in the Schedule;
• to the extent such contract or agreement requires the person or organization to be
afforded status as an insured;
• for activities that did not occur, in whole or in part, before the execution of the
contract or agreement; and
• with respect to damages, loss, cost or expense for injury or damage to which this
insurance applies.
No person or organization is an insured under this provision:
• that is more specifically identified under any other provision of the Who Is An
Insured section (regardless of any limitation applicable thereto).
• with respect to any assumption of liability (of another person or organization) by them in
a contract or agreement. This limitation does not apply to the liability for damages, loss,
cost or expense for injury or damage, to which this insurance applies, that the person or
organization would have in the absence of such contract or agreement.
Liability Insurance Additional Insured - Scheduled Person Or Organization continued
Form 80-02-2367 (Rev. 5-07) Endorsement Page I
Liability Endorsement
(continued)
Under Conditions, the following provision is added to the condition titled Other Insurance.
Conditions
Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization
Primary, Noncontributory Insurance -Scheduled shown in the Schedule with primary insurance such as is afforded by this policy, then in such
Person Or Organization case this insurance is primary and we will not seek contribution from insurance available to
such person or organization.
Schedule
PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO A
CONTRACT OR AGREEMENT, TO PROVIDE WITH SUCH INSURANCE AS IS
AFFORDED BY THIS POLICY.
All other terms and conditions remain unchanged.
Authorized Representative
Liability Insurance Additional Insured - Scheduled Person Or Organization last page
Form 80-02-2367 (Rev. 5-07) Endorsement Page 2